Suicidal Patients: Documentation and Disposition

by Sharon Bord, MD

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    00:02 You wanna make sure that you’re documenting these accounts clearly.

    00:05 This is very challenging history to diagnose sometimes or to document because you wanna make sure that you’re documenting restraints or potentially involuntary commitment to the hospital.

    00:18 You wanna know especially if you’re gonna involuntarily commit your patient, how is the patient at risk of harm to themselves or others? You wanna talk with collaterals.

    00:31 Again, you wanna involve family members, friends, therapists, anyone else who many know the patient better who might be able to give you additional information.

    00:41 And additionally, you wanna make sure that you document clearly a follow-up plan.

    00:46 So these are all things that you wanna make sure that you’re writing down in the medical record.

    00:51 Disposition for these patients, we have a few options.

    00:55 So the first is admission to a psychiatric hospital.

    00:58 Now, patients definitely do get admitted to the psychiatric hospital If we’re concerned that they’re at risk of harming themselves or harming other people, if we’re worried about their safety, if we think that they’re very depressed and they would benefit from this. But in the literature, there’s actually debatable efficacy for an inpatient psychiatric admission and some people say that close outpatient follow-up may have better or similar outcomes actually.

    01:23 Now again, that’s not to say that patients shouldn’t be admitted to the psychiatric hospital.

    01:28 We just wanna make sure that we’re selecting the appropriate patients to go there.

    01:32 Another option is involuntary or emergency commitment.

    01:37 This varies state by state, so there’s different laws in each state, and the time in which you can hold someone is between 72 hours and 15 days.

    01:46 Sometimes these involuntary commitments are started by the physician who’s caring for the patient, but sometimes and in certain states, a family member, or a concerned friend or individual who sees the patient can go ahead and create this involuntary commitment for the patient.

    02:03 And then, some patients are gonna be able to go home after evaluation.

    02:07 One thing you wanna be sure is that that patient can have close follow-up with a mental health professional.

    02:13 Ideally, they’re gonna be seen within 72 hours.

    02:17 We wanna make sure we provide resources and patient education.

    02:21 And we wanna also discuss with family and the patient, temporary removal of guns or firearms, if they’re located at home.

    02:29 So in conclusion, suicidality is a common presenting complaint to the Emergency Department.

    02:35 Risk factors include access to firearms, substance abuse, or a mental health history.

    02:42 Elderly white males are the highest risk group but are by no means the only people who are involved here.

    02:48 So in the Emergency Department, our main goals of care include identification of acute medical illness as well as patient and staff safety.

    02:57 Disposition decisions can be very complicated here.

    03:00 If discharged, patients should ideally have follow-up with a mental health provider within 24 hours and you also wanna be sure that your patient has good resources and good return instructions to the Emergency Department.

    About the Lecture

    The lecture Suicidal Patients: Documentation and Disposition by Sharon Bord, MD is from the course Neurologic and Psychiatric Emergencies.

    Included Quiz Questions

    1. The period varies by jurisdiction.
    2. It is no longer practiced.
    3. It is only allowed for patients who require medical treatment.
    4. It is the best proven method of preventing suicide.
    5. It has less than optimal outcomes compared to outpatient involuntary commitment.

    Author of lecture Suicidal Patients: Documentation and Disposition

     Sharon Bord, MD

    Sharon Bord, MD

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